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General NPI Number Information
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NPI Number | 1346432010
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Entity Type | Organization
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Legal Business Name | BRANDON MEDICAL GROUP PLLC
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Dates
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Enumeration Date | 08/15/2007
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Last Update Date | 06/05/2012
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Provider Practice Location Address
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Address Line | 482 INTERSTATE DR STE A
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City | MANCHESTER
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State | TN
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Zip | 37355-3109
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Country | US
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Telephone | 931-728-4718
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Fax |
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Provider Business Mailing Address
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Address Line | 482 INTERSTATE DR STE A
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City | MANCHESTER
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State | TN
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Zip | 37355-3109
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Country | US
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Telephone | 931-728-4718
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | ALBERT R BRANDON
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Credential | D O
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Telephone | 931-728-4718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO212
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License Number State | TN
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